Socket Preservation using Enzyme-treated Equine Bone Granules and an Equine Collagen Matrix: A Case Report with Histological and Histomorphometrical Assessment.

AIM: To histologically assess the effectiveness of a socket-preservation technique using enzyme-treated equine bone granules as a bone-graft material in combination with an equine collagen matrix as a scaffold for soft-tissue regeneration. BACKGROUND: Enzyme-treated equine bone granules and equine collagen matrix recently have been developed to help overcome alveolar bone deficiencies that develop in the wake of edentulism. CASE REPORT: The patient had one mandibular molar extracted and the socket grafted with equine bone granules. The graft was covered with the equine collagen matrix, placed in a double layer. No flap was prepared, and the gingival margins were stabilized with a single stitch, leaving the matrix partially exposed and the site to heal by secondary intention. The adjacent molar was extracted 1 month later, and that socket was left to heal by secondary intention without any further treatment. Three months after each surgery, an implant was placed and a biopsy was collected. The two biopsies underwent histological processing and qualitative evaluation. Histomorphometric analysis was also performed to calculate the percentage of newly formed bone (NFB) in the two cores. Healing at both sites was uneventful, and no inflammation or other adverse reactions were observed in the samples. Soft-tissue healing by secondary intention appeared to occur faster at the grafted site. The corresponding core showed a marked separation between soft and hard tissue that was not observed in the core from the nongrafted site, where soft-tissue hypertrophy could be observed. Newly formed bone at the grafted and nongrafted sites was not significantly different (27.2 ± 7.1 and 29.4 ± 6.2% respectively, p = 0.45). CONCLUSION: The surgical technique employed in this case appeared to facilitate postextraction soft-tissue healing by second intention and simplify soft-tissue management. CLINICAL SIGNIFICANCE: Using a collagen-based matrix to cover a postextraction grafted site may facilitate second intention soft-tissue healing and proper soft-tissue growth.

Quality assessment of systematic reviews on alveolar ridge preservation.

BACKGROUND: The authors conducted a study to assess the quality of systematic reviews (SRs) published on the topic of alveolar ridge preservation (ARP). TYPES OF STUDIES REVIEWED: The authors conducted a search for SRs on ARP on the basis of a set of eligibility criteria (only SRs involving ARP, with or without meta-analyses, written in English). The authors assessed the quality of the SRs independently of one another by using two established checklists. RESULTS: The authors selected eight SRs. The results of all of the SRs indicated that ARP was effective in preserving the ridge volume as compared with extraction alone, but it did not fully prevent bone-resorptive events. None of the SRs, however, received the highest possible score in either of the checklists. One SR that had a score of 5 (of a possible 11) using one checklist and 5 (of a possible 14) using the other checklist had the lowest overall score. The results of this assessment revealed that a significant proportion of the investigators in the SRs did not include non-English language articles, perform hand searching of published literature or evaluate the gray literature. Assessment of publication bias and reporting of conflicts of interest also was lacking in some studies. Practical Implications. Although ARP appears to be an effective approach to preventing resorption after tooth extraction, significant structural and methodological variability exists among SRs on this topic. Future SRs on ARP should consider the use of quality assessment checklists to minimize methodological shortcomings for better dissemination of scientific evidence.

Case report: Forensic anthropological assessment in a suspected case of child abuse from South Africa.

Not many case reports of suspected child abuse as assessed solely on skeletal remains are available. Forensic anthropologists have intimate knowledge of normal skeletal anatomy, bone trauma and processes of healing of bone and may therefore be of help in suspected cases of child abuse. Patterns of trauma in juvenile skeletal remains which are suggestive of abuse include fractures in different phases of healing, multiple fractures, typical fractures on ribs and long bones and severe, complicated cranial fractures. The aim of this paper is to report on the findings of the analysis of the skeletal remains of a 3.5 years old boy. Forensic pathological examination indicated that the boy had died from a massive cranial fracture, with multiple injuries present to the rest of the body. After the body had been buried for some time, it was exhumed and we were requested to look for signs of chronic, long-term abuse. Findings included a massive cranial fracture, another fracture in the roof of the orbit, two areas of non-specific subperiosteal bone growth and several untreated carious teeth. No clear healed fracture could be found, except for a possible healed cranial base fracture which stretched transversely across the petrosal bone. This area showed signs of recent bone activity. The court decided that this was not enough evidence of chronic abuse and found the accused guilty of murder but not of chronic child abuse. This case illustrates the difficulty to obtain clear signs of chronic injury on juvenile remains.

Using the support immersion endoscope for socket assessment.

BACKGROUND: The purpose of this study was to determine the indications, efficacy, and advantages of the support immersion endoscope (SIE) method for extraction socket assessment. METHODS: Twelve patients (four women and eight men; mean age: 28 years) in need of extraction with implant placement participated in the study. The teeth extracted included eight upper central incisors and six upper lateral incisors. Extraction sockets were evaluated with a conventional extraction site evaluation (CESE) method alone or with CESE + SIE. CESE includes: visual evaluation; periodontal probing; ridge mapping with calipers, dental mirror, and orthopantomogram; and diagnostic wax-up. RESULTS: CESE + SIE had significantly better accuracy in examining extraction socket labial plate vertical position, labial plate thickness, and bone quality compared to CESE alone. The results obtained from CESE assessment were inconsistent because of poor visualization. CONCLUSION: The SIE can be used as an adjunct tool in assessing extraction socket morphology and bone conditions without flap elevation.

Extraction defect assessment, classification, and management.

Tooth extraction is a traumatic procedure initiating a complex cascade of biochemical and histologic events that inevitably lead to a reduction of alveolar bone and soft tissue. These tissue alterations often lead to an esthetic compromise of the future implant restoration. The hard- and soft-tissue architecture surrounding the extraction defect largely dictates the course of dental implant treatment. The EDS or extraction-defect sounding classification is a novel system introduced to simplify the decision-making process when planning for dental implant therapy following tooth extraction. Dental implant treatment guidelines based on the EDS classification are discussed. A review of pretreatment evaluations necessary to prepare for esthetic implant procedures is also presented.